Testosterone is the male sex hormone that gives men their manliness. It’s produced in the testicles and is responsible for male characteristics such as a deep voice, muscular build, and facial hair. This hormone also aids in the production of red blood cells, boosts mood, aids in thinking ability, and keeps bones strong. Testosterone levels usually decrease with age, so older men may experience lower testosterone levels in their later years. Unfortunately, some men may experience low testosterone earlier in life, and the unwanted symptoms that are associated with it.
What is Low Testosterone
Lowered testosterone, also referred to as “Low T”, levels may occur in male patients over the age of 40. These levels peak in early adulthood and then begin to drop – about 1% to 2% a year beginning in the 40s – as you age. The term Low Testosterone refers to a testosterone deficiency in the body and means the body does not have enough of a needed substance.
The American Urology Association (AUA) labels low testosterone as less than 300 nanograms per deciliter (ng/dL). There are many signs and symptoms of Low Testosterone. Your provider will help make sense of your own situation. Symptoms of Low Testosterone may include:
- Low sex drive
- Reduced lean muscle mass
- Erectile dysfunction
In addition, there are also non-specific signs and symptoms of Low Testosterone. Those signs may include:
- Lower energy levels, endurance, and physical strength
- Poor memory
- Poor focus
What causes Low Testosterone
In certain cases, some men may be born with conditions that cause Low Testosterone such as Klinefelter syndrome, Noonan syndrome, or ambiguous genitalia – when the sex organs develop in ways that are not typical in appearance. Others may develop Low Testosterone because of damage to the testicles, cancer-related removal of the testicals, chemotherapy or radiation, pituitary gland disease that leads to a hormone deficiency, infection, or autoimmune disease – when the body produces antibodies that attack its own cells.
Ultimately, if your testicles are making less testosterone than normal, your blood levels of testosterone will fall. Men who develop a testosterone deficiency have Low Testosterone levels that can be linked to aging, obesity, metabolic syndrome, or uses of medication such as antidepressants and narcotic pain medications.
Diagnosing Low Testosterone
A provider will diagnose Low Testosterone based on the information gathered from a physical exam, a review of the patient’s symptoms, and the results of multiple blood tests due to the fact that levels can fluctuate daily.
If you are diagnosed with Low Testosterone by your provider, other tests may be considered before a therapy plan is developed. For example, Low Testosterone can hasten bone loss, so your provider may suggest a bone density test to determine if there is also a need for treatment for osteoporosis.
Prostate cancer can be another concern for men with Low Testosterone, as it can fuel the cancer’s growth. As a result, the Endocrine Society suggests against testosterone supplementation for men in certain situations, such as those who:
- Have prostate or breast cancer
- Have an elevated blood level of prostate-specific antigen
- Have a prostate nodule that can be felt during a rectal exam
There are other circumstances where testosterone supplementation is not recommended. Those may include:
- Desire to father a child in the near future
- Elevated red blood cell count
- Severe lower urinary tract symptoms
- Heart attack or stroke within the last 6 months
- Severe, untreated sleep apnea
- Tendency to form blood clots
- Poorly controlled heart failure
Low Testosterone Treatment
Recently, the media has reported about more testosterone replacement therapy, and more men between the ages of 40 and 65 have utilized this form of treatment. In some cases, men with Low Testosterone may want testosterone therapy even without being tested to begin with. Therapy without the need may not be safe or helpful for these patients. Total testosterone levels should always be tested before any form of testosterone therapy, and the AUA recommends testosterone therapy only be utilized by men who meet the clinical and laboratory definition of deficient testosterone levels.
In most cases, men need to have both low levels of testosterone in their blood and several symptoms of Low Testosterone to undergo testosterone therapy.
While uncommon, it is possible to have low levels and not experience any of the related symptoms. With that said, if you do not experience any of the key symptoms, especially fatigue and sexual dysfunction, which are the most common, it is not recommended that you go on testosterone therapy given the uncertainty about its long-term safety.
Even if your levels are low and you are experiencing several of the symptoms of Low Testosterone, testosterone therapy is not always the best plan of attack. If your provider can identify the source of the declining levels – such as weight gain or a certain medication – they may first address that problem before resorting to testosterone therapy.
If you and your provider feel that testosterone replacement therapy is the best choice for you, there are a variety of delivery methods that can be considered:
- Skin patch – applied once every 24 hours, this patch releases small amounts of the hormone into the skin.
- Gels – Topical gels are applied directly onto the skin over both upper arms, shoulders or thighs. It is important to thoroughly wash your hands after applying and to cover the treated area with clothing to prevent exposing others to testosterone.
- Pellets – Implanted under the skin, testosterone pellets are usually placed around the hips or buttocks, and slowly release testosterone and should be replaced every three to six months.
- Injections – Different formulations are injected every seven to 14 days. Your T levels can rise to high levels for a few days after the testosterone injection and then slowly come down, which can cause a rollercoaster effect, where mood and energy levels may spike before lowering once again.
Most men are able to tell a difference in symptoms within four to six weeks of taking testosterone replacement therapy, although changes like increases in muscle mass may take three to six months.